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A novel approach of intraoperative cholangiography in laparoscopic left lateral sectionectomy in living donor liver transplantation

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Abstract

Background

Accurate division of bile duct during laparoscopic donor hepatectomy in living donor liver transplantation is essential. We here present a novel approach to achieve cholangiography via the bile duct stump of segment IV (B4 stump) during laparoscopic donor hepatectomy in adult-to-pediatric living donor liver transplantation.

Patients and methods

Donors who underwent laparoscopic left lateral sectionectomy (LLLS) from January 2022 to April 2022 in our liver transplant center were retrospectively analyzed. A total of 32 donors were eventually enrolled into this study. Cholangiography via the B4 stump was performed in 11 donors (B4 group) while indocyanine green (ICG) fluorescence guiding was performed in 21 donors (ICG group). Perioperative data were collected and compared between groups.

Results

Cholangiography by catheterizing the B4 stump was successfully performed in all 11 donors in the B4 group. The mean time of this procedure was 12.82 ± 9.11 min. Compared to the ICG group, it was more likely to acquire single bile duct orifice on graft in the B4 group (B4: 10/11, 90.91% vs ICG: 9/21, 42.86%) and it was significantly different (p = 0.030). The donors’ complications (Clavien-Dindo grade III-IV) were not significantly different. There was one donor developed intraperitoneal effusion in B4 group, while two donors (one bile leakage and one biliary stricture) developed biliary tract related complications in the ICG group. A Roux-en-Y was performed to solve the biliary stricture in the ICG group. The recipients’ outcomes were not significantly different between groups.

Conclusions

Cholangiography via the B4 stump catheterization is feasible and safe in identifying the bifurcation of bile duct during LLLS.

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Abbreviations

LLLS:

Laparoscopic left lateral sectionectomy

B4:

The bile duct stump of the segment IV

ICG:

Indocyanine green

MRCP:

Magnetic resonance cholangiopancreatography

PLDLT:

Adult-to-pediatric living donor liver transplantation

GRWR:

Graft to recipient weight ratio

BMI:

Body mass index

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Acknowledgements

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Funding

This study was supported by grants from Capital’s Funds for Health Improvement and Research (No.2020- 1–2024) and Beijing Municipal Science & Technology Commission (No. Z211100002921026).

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Author notes

  1. Hongyu Li and Lin Wei have contribute equally to this article.

Authors and Affiliations

  1. Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

    Hongyu Li, Lin Wei, Zhigui Zeng, Wei Qu & Zhijun Zhu

  2. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

    Mingyue Zhu

Authors
  1. Hongyu Li
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  2. Lin Wei
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  4. Zhigui Zeng
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Corresponding author

Correspondence to Zhijun Zhu.

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Disclosures

Drs. Hongyu Li, Lin Wei, Mingyue Zhu, Zhigui Zeng, Wei Qu and Zhijun Zhu have no conflicts of interest or financial ties to disclose.

Ethical approval

The operations were approved by the review board of Beijing Friendship Hospital, Capital Medical University. Following requirements of the Chinese and Beijing governments, each case of living donor liver transplantation was provided with independent ethical and administrative approvals.

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Li, H., Wei, L., Zhu, M. et al. A novel approach of intraoperative cholangiography in laparoscopic left lateral sectionectomy in living donor liver transplantation. Surg Endosc 37, 4974–4981 (2023). https://doi.org/10.1007/s00464-023-10066-1

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  • DOI: https://doi.org/10.1007/s00464-023-10066-1

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